P_Instructor

They're paying for the facility.....let them use it for their own desires. They may be soggy in body, but crisp in mind! These are the type of patients that are fun to have.

Any action, whether deliberate or not, attention getting or suicidal, where there was an attempt to harm self needs evaluation. Force the PD to put them in protective custody and transport him. Let MC know the circumstances also.

I have to agree with our esteemed colleague spenac. Doing the research on your own is imperative. Everyone who has posted above has had to do what is now asked of you. While we may offer different styles of studying, the premise is the same. Write on an index card what you think is required information. Read these cards, record and listen to them over and over until you can make a new set of cards from memory. I broke my drugs up in to categories. I placed all cardiac medications together and studied them as a unit. Then airway medications. Then, well, you get the idea.

While it may seem tedious and lengthy to make out your own drug cards, the pharmacology section of your paramedic class flunks out the majority of the students in my experience. There really is no shortcut. You HAVE to know this stuff.

Information I had on my cards was;

-Drug name, Generic and trade, we use Zofran as an antiemetic. On the vial though it is called Ondansetron.

-Dosages and route of administration as some dosages change with the route ie: Torodol 30mg IV, 60mg IM

-Indications for use

-Contraindications for use

- Side effects of the medication

- Desired result of administration

Good luck with your class!

Cool. I agree with you and Spenac. RESEARCH!!!! There are many resources that you can draw from. There is program individuality on information that is requested. I ask of my students: Name of Drug (Generic and trade), Type of drug, Indications for use, Major Contraindications (all that apply), Side Effects, How the drug is supplied, Dosages (adult and peds) as well as how delivered for all specific instances, and also have the students list any other special considerations if there are any.

2-4 mg IF THE BP WILL SUPPORT IT is the "recommended" dose of morphine for any MI. For an inferior you would want to get the BP up first, give the NTG and ASA, and then Morphine (if the BP is still above 90 to 110 depending on your protocol) The patient needs to reduce the oxygen demand on the heart and morphine will do that.

I believe it is all relative dependant on your protocols and your assessment and decision making skills based on what you have. CP patient's with true cardiac problems may also benefit with ASA, and NTG/MS admin dependant on clincal findings. We have had good success in relieving CP with administering NTG followed by immediate MS, creating less demand on the myocardium. (this is all relative again to hemodynamic stability)

Another point on D50, how many patients do we push a full amp (25g) of D50 and get a refusal for transport when we should be talking our patient into going to the ER to be checked out. The number of times I have heard a medic say "well your sugar was just a little low, you don't need to go to the hospital just sign here" when dealing with a patient they found altered or unresponsive makes me sick. If the patient is to altered to eat something then they need to be checked by a doctor even if the only reason their sugar is low is something as simple as they did not eat dinner last night. I work under the

you call we haul theroy, I would much rather get called in to a supervisor's office to explain someone calling to complain about me trying to talk them into going to the ER then having to go back and work a full arrest on a patient I talked out of going to the hospital. Just my two cents on D50 in EMS

Watch out. Pushing D50 and the patient waking up is one thing, but when they refuse and you have them sign a refusal without contacting medical control, you are basically practicing medicine without a license. Check the legalities with your medical director. I agree the patient should be treated and transported. If there is some sort of dilema that you have to treat in the dwelling (because of size, extrication problems, etc.) do so, and then if the patient refuses, talk to medical control or have the patient talk to medical control to put that on their shoulders, not yours.

If you have to use an IO, you have poor IV skills.

AMEN BROTHER!

90% of the time the diabetic patient that you wake up is going to refuse transport. (no studies to back it up but that's what my numbers seem to show).

10% of the patients that don't refuse transport fall into the following two categories

1. they are the ones who I've already put in the ambulance and started to transport

2. The others are the ones who are feeling poorly before this happened and they want to be looked at.

I ALWAYS offer transport, never offer refusal.

Now for the IO discussion

I have started a IO on three adults in the last 12 months.

1. seizure patient who by our experiences with him had no veins whatsoever and he required IO to administer valium for the seizure

2. Trauma patient with near total circulatory shut-down

3. Diabetic patient without any vein including the EJ - (patient was transported prior to infusing the d-50)

If you don't have an IV and you need one there is nothing wrong with starting an IO. From what I've read there is no more risk in an IO than an IV. Plus I have been told that the IO hurts less than some IV's but I'm not sold on that.

We use the EZ IO drill and it seems to work great on the three I've started the IO's on.

Removal of the IO is pretty straightforward and simple and from the responses I have seen from the 3 patients it hurts more coming out than in.

I know this is off subject for this particular forum, but why not try Midazolam (Versed) IM for the seizures before the IO? It absorbs faster than Valium and does work well in our system.

It does depend on the system that you work for as well as the area you service. I believe that it also depends on the type of person you are. I've worked both the 24 and 12 (day and night) shifts. The only draw back is screwing your biorhythms up when you keep changing the shift pattern. It does create a provider to patient problem when you are up and working for the whole 24 hour shift (it can be done, but who wants to keep the coffee companies in business). My advice is if your employer is willing to let you try out each shift, do so, and choose the one that best fits.

The younger ones seem to be having a difficult time mastering peripheral IVs. Imagine if they had started in EMS several years ago when we had to maintain competency in all of the skills I listed and were even expected to be proficient at Endotracheal Intubation?

I agree. Knowledge is great, but you need the competency/skill mastery along with the knowledge base to be a good Medic. They go hand in hand. I think that institutions that provide the National Registry Skill Evaluation need to step up their game. I hammer my students (and also get headaches from banging my head against the wall) every day on skill mastery. They get to the skill stations and breeze right thru them, then come back to me and say they were too easy (wow, get that from a student!). If they are not competent in the clinical setting, keep on them until they can do it in their sleep, then scenario them to the brink of extinction using knowledge and skills to be a good Paramedic.

Yes, but you must remember the Subclavian was taught in the Paramedic text books for many years and central lines are still in some ground ALS protocols and not just for Flight or Specialty. Subclavian lines were no different than chest tubes, intracardiac epi and pericardiocentesis which were all part of the regular Paramedic curriculum not that long ago. Just 20 years ago we didn't have a helicopter and a trauma center on every corner.

Thanks. It was meant for a snicker or two, but I am apparantly like you.....an old time Medic (20+ years) who had the old curriculum and was taught these skills. I just wanted to see how 'wide-eyed' the newer Medics would respond.

I am preparing a course specifically for first responders in developing countries, and will be going abroad with a group to instruct twice a year. Any advice on modifying a course to make it appropriate for these learners? Has anyone actually done this and can offer advice? Thanks so much!

How intense is the subject matter? Are you thinking like a First Responder course or EMT-Basic course? First out of the gate, look at the First Responder with additions that would meet the needs of the country and area you will be teaching.

Are subclavian CENTRAL lines still in your protocols?

A femoral central line would present a few less risks but is still not a preferred route in the prehospital field setting.

The EJ is a peripheral line and it used frequently both in the hospital for rapid access as well as by many EMS agencies.

If someone or even all in agency can not get the EJ procedure done correctly, I don't think I would want them digging around for a subclavian or femoral central line.

I apologize...it was meant to be in fun only. Subclavians are cenral lines, and have worked with them in the aeromedical field only upon very discipline Medical Direction only. Have also done a couple of femorals. I do agree with you completely. The EZIO is probably my best choice, even though the EJ is not difficult if done correctly (which would be dependant on availability or position for access).

Again, sorry for the confusion.

Perfect Medic vs. Nurse story....Working flight (rotorwing) shift with new flight nurse. All he wanted to do was be able to intubate someone. Tired of all the practice and wanted 'real' patient. Got request for scene flight with local service and information received was for 'cardiac arrest'. The nurse's eyes got big and very happily offered his services to intubate the patient in which I replied, "Hell, I don't care as long as it gets done". As the nurse was getting the airway equipment ready, I began thinking (as a paramedic would), how can I screw with him? We landed at the scene and exited the aircraft. Walking up to the ambulance that housed the patient, I realized this was my chance. I asked the nurse if they had the monitor in which their was this perflexed look of confusion on his face, realizing that he forgot to grab it. He immediately retraced his steps to the aircraft to get the needed equipment. As this was being done, I entered the ambulance via the side door and took airway control. As I was intubating the patient, the nurse opened the back door and viewed me now confirming proper placement with this astonished look on his face. Little did he realize (but which I knew) the service already had a monitor/defibrillator placed on the patient. My only words to him was............ROOKIE! He had never forgotten this incident and still shakes his head everytime there is the possibility of intubation. And you can bet I will never let him forget.

Ask him if the IAFF supported the ORIGINAL National Scope of Practice document.

Argument over.

Perfect response!

Hey all,

One of the guys I work with is a fire medic and we got into an argument this morning concerning Fire and EMS. My argument was that most of the times that EMS has attempted to make a run at creating an entry level AAS for paramedic medicine that Fire has consistently opposed it. He claims that this is nonsense, that the fire unions are pro education and responsible for many increases in EMS education.

I'm looking for articles, as I know I've seen a lot of them, to support my argument that Fire consistently stands in the way of increased education in EMS.

I have no doubt that both arguments can be supported, but I am looking for support for mine only. Though I would be interested in seeing another thread to support the opposite if possible.

It is not my intention to start a flame war here. I have many, many friends that also happen to be infected by the Firebug. This is a good natured argument between a medic I respect and myself and I simply want to smite him in a good natured way. I simply don't have the time, or the mad Google skills to do so on my own in short order.

I'm asking as a favor that we avoid having this thread locked by keeping it in that spirit.

Thanks for any help you can provide.

Dwayne

I think it just may be your area. I currently instruct a Paramedic class that can be offered either diploma (just the Paramedic class) or also the AAS (Paramedic class with specific college course requirements). The kicker is that the current class has 4 fire fighters (1 basic and 3 intermediates), all looking to improve their own knowledge and skill base. The aspect of starting Paramedic Engine Companies is a National trend, but could have problems (i.e. the Naples, Florida debacle) unless everything (and I mean everything) is completely spelled out in what needs to be done and what is expected. My opinion is that many Fire Departments are looking into EMS because we handle more call volume (even though we are reimbursed less). This sounds like job security. It will also be determinate upon if Fire Departments are transporting patients or just providing first response (non-transport).

I believe the majority that the fire unions are pro education and responsible for many increases in EMS education is FALSE.

Personal note - Love the area around there, vacationed at Royal Gorge and made it into Canon City numerous times.

I bet if the dog was a Dalmation, it would have been given a burial with a Honor Guard!

Has anyone thought about a subclavian? Lets break out the 14G (2.1mm) 5 1/4 (13.3cm) Angios and head for the hills!

Your state will have to do better than this to beat Florida or California in the category of "Stupid EMS/FD Headlines".

I think Florida has already had a couple of FFs admiring and/or photographing the boobs of patients when they shouldn't have been.

Well it always takes a "BOOB" to want to photograph a 'Boob'.

Medical Directors NEED to take an active role in pre-hospital medicine and care. The paramedic is working under THEIR license. It is to the point now that even when taking a Paramedic class, the National Registry will soon not test anyone unless they come from an accredited institution. To become an accredited training facility, it is imperative that there is ACTIVE MEDICAL DIRECTOR involvement. This is what the country needs. Competent Paramedics that are looked over by medical leadership in the emergency field. Trust me, I know. We've recently become accredited and this was one main point in the process-------ACTIVE MEDICAL DIRECTORSHIP in training and operation of services rendered to the public, our clients that pay our wage.

Who in their right mind would want to become the Medical Director for this Department? No pun intended, but I thing the FD 'burned' the only bridge they had. I would not grant anything unless all the evidence was presented, and there was a complete CQI process in place and place the service on 'probation' for a minimal of 2 years until everything has compliance. The new Medical Director better know what he is getting into, or the union may just pay under the table for one to get their wishes......easy street without having to do anything, and non-competence in the public's expected standard of pre-hospital care.

They want to be firefighters, let them. Get them out of the Paramedic field. Deny any application for Paramedic status and leave it to the true professionals that provide the competent care.

OK, So we have the Medical Director doing his job, the Fire Department in an uproar because they don't like the way he supposed to do his job, the FD union throwing their weight around, the council cowering underneath their desks, Firefighters not keeping up on their skills, the public potentially suffering the consequences, cats fighting dogs, mass hysteria...............

Question......What in the State EMS Bureau/Department doing about this? Are they involved in any investigation? Should they be? Oh yeah, State of Florida. This could come down to a recount.

Fire the FF/Medics, retain the Medical Director, kick the Councils Butts, and what is the true public opinion?

From Wikipedia, the free encyclopedia

Within emergency medical services a medical director is a physician who provides guidance, leadership, oversight and quality assurance for the practice of local paramedics and EMTs within a predefined area. The medical director is generally responsible for the creation of protocols for treatment by paramedics. The medical director may also assist the EMS agency in extending its scope of practice. While this definition is a fair description of the role in North America, significant variations can occur in other countries and in other health care systems.

Note: In the interest of clarity, medical directors exist in a variety of other settings in addition to EMS. It is largely a generic term used to describe a physician who has responsibility for the medical control and direction of various types of organizations.

Enough said. These gentlemen are working under the medical directors license and need to follow his rules. Rarely do you see a Medical Director that is this involved within the EMS community. I applaude this Medical Director for he is making sure that the Medics that work under his guidance meet the criteria to provide the upmost care.